Expert: Mark Bornfeld DDS - 9/29/2007

Question
Last weekend i was out of state and the tooth right before the molar on the left side was killing me. I went to my dentist 4 days later when i got back in town and he took x-rays and saw some decay under an old filling done by my old dentist. My new dentist said he would have never put a filling that big into a tooth like that. Anyways he always tells me my options and he said he could fill it back up like the other hack did to me or he could crown it. So we both agreed that a crown sounded like the thing to do. Everything seemed to go well and i had a temp. crown in my mouth and my dentist said it should be pain-free in a few days. So the next day it was just as bad as the few days with it and the next night i couldn't take it anymore so i called my dentist using his emergency # b/c it is the weekend. I have been taking Ibuprofen 800mg and my dentist just prescribed me Penicillin. He thinks there may be an infection. The pain keeps getting to the point where it's almost unbearable now b/c i have been dealing with it for a few days off and on probably 20 hrs a day. I have tried warm salt water, ice packs, and Ibuprofen 800 but nothing really seems to work. How long should i start to feel the Penicillin kick in? Is there anything else i can do? I have only been able to get 2.5-3 hrs of non-stop sleep when I'm lucky. Today is Saturday and my dentist is out of town till Monday at 2 and he wants to see me ASAP. Also i have not had any visible swelling and the ice packs worked at first but now they have little or no effect on the pain. Any suggestions on what to do with the time i have left? Thanks so much i appreciate it!

Answer
Dear Jamie,

Unfortunately, I don't think the stage of infection in which your tooth finds itself will be much relieved by antibiotics; it's too early an infection to be accurately called an infection. More likely, you have what is known as a "pulpitis", and the most effective means of providing relief is to remove the superficial parts of the nerve-- a so-called "pulpotomy". Unfortunately, your dentist cannot provide any hands-on intervention while he is out of town, so the next best thing would probably be for him to phone in a prescription for a stronger pain medication, such as a narcotic, to your local pharmacy. As an alternative, he may be able to refer you to a colleague who may be able to provide more timely relief. If not, you might give some consideration to contacting your local dental society for referral to a local dentist who may be able to assist until you can see your regular dentist. You can find your local dental society at the following web site:

http://www.ada.org/ada/organizations/local.asp

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY